Surgery More Effective Than Nonsurgical Treatment for Spinal Stenosis

A new study reports that surgery for the relief of symptoms associated with lumbar spinal stenosis offered a significant advantage over nonsurgical treatment in terms of pain relief and functional improvement, an improvement that was maintained at 2 years follow-up.

Researchers at Dartmouth Medical School (Hanover, NH, USA) conducted a multicenter trial known as the Spine Patient Outcomes Research Trial (SPORT), which included patients from 13 medical centers in the United States with multidisciplinary spine practices. The study included a randomized cohort of 289 patients and a concurrent observational cohort of 365 subjects who opted not to be randomized. In the randomized cohort, 138 patients were assigned to surgery and 151 to nonsurgical treatment. Study interventions included standard posterior decompressive laminectomy or usual care, which was recommended to include, at least, active physical therapy, education, or counseling with home exercise instruction, and the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) if possible. The effect of treatment was defined as the difference in the mean change from baseline between the surgical group and the nonsurgical group.

The researchers reported that the as-treated analysis, which combined both cohorts and adjusted for potential confounders, showed a significant advantage for surgery by 3 months for all primary outcomes, which remained significant at 2 years. They also reported that the treatment effect for surgery was seen as early as 6 weeks, appeared to peak at 6 months, and persisted for 2 years. However, there was only moderate improvement among patients in the nonsurgical group during the 2-year study period; additionally, after two years, 67% of patients who were randomly assigned to surgery had undergone surgery, and 43% of those who were randomly assigned to receive nonsurgical care had crossed over and received surgical treatment. The study was published in the February 21, 2008, issue of The New England Journal of Medicine (NEJM).

"Patients with spinal stenosis without degenerative spondylolisthesis who underwent surgery showed significantly greater improvement in pain, function, satisfaction, and self-rated progress than did patients who were treated nonsurgically,” concluded lead author James N. Weinstein, M.Sc., D.O., and colleagues.


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